Exercise Induced Bronchoconstriction
Key Points
Key Points
- The major trigger for bronchoconstriction in a vulnerable subject is either water loss during periods of high ventilation or the addition of an osmotically active agent.
- Exercise itself is not needed to cause bronchoconstriction, just the creation of a hyperosmolar environment.
- The hyperosmolar environment leads to mast cell degranulation with release of mediators, predominately leukotrienes, but also including histamine, tryptase, and prostaglandins. In addition, eosinophils can also be activated, producing further mediators, including leukotrienes.
- The water content of the inspired air, the level achieved and maintained during exercise, or both are the major determinants of exercise-induced bronchoconstriction (EIB).
- EIB is frequently documented with asthma and reflects insufficient control of underlying asthma.
- Elite athletes have a higher prevalence of EIB than seen in the general population, varying with the intensity of exercise and the environment.
Diagnosis
...agnosis...
...ment (SS)1: In asthmatic patients EIB can indica...
SS2: A diagnosis of EIB should be...
SS3: Evaluate EIB in elite athletes by...
...Perform a standardized bronchoprovocation (exerci...
...with no current clinical history of asthma, use a...
...6: Use an indirect graded challenge (...
...indirect challenge (eg, exercise challen...
...e the ventilation reached and sustained during exe...
...: Perform EVH as the preferred surr...
...ndirect graded challenge (eg, mannitol) result is...
SS11: To differentiate between EIB and exerc...
...determine whether exercise-induced dyspnea an...
...pirometry, as well as detailed pulmonary...
...Consider a diagnosis of exercise-i...
Treatment
...eatment...
...5: Refer to appropriate specialists (eg, cardiolo...
...Refer patients for psychological...
...17: Schedule regular office visits with pa...
β2-Adrenergic Receptor Agonists
SS18: Prescribe inhaled short-acting β2...
...be a single dose of SABA, LABA, or both on an int...
SS20: Be cautious in daily use of β2-adrener...
...kotriene Inhibito...
...S21: Consider prescribing daily therapy wit...
Mast Cell Stabi...
...r prescribing inhaled cromolyn sodium...
...CSs...
...er prescribing ICSs in combination with other...
...Do NOT prescribe daily LABAs with ICS...
...cholinergic Agents...
...ider prescribing inhaled ipratropium...
...harmacologic Therapy...
...pre-exercise warm-up for EIB becaus...
...der with caution the recommendation o...
...tive and Elite Athletes...
...8: Treat athletes with EIB alone in a similar...
...1. Algorithm for the Diagnosis, Treatment, an...